Two Languages

There are two languages in surgery.

Not spoken languages. Not the Latin roots of anatomical terminology or the shorthand of the ward round. I mean something less formal and more consequential than that. I mean the ways of being that determine how you are read before you have said anything worth reading. The signals that rooms receive before you have made your argument. The impression that forms in the first minutes of a high-stakes encounter and then, quietly and without announcement, shapes everything that follows.

I learned one of those languages at home, long before I understood that it was a language at all. The other I had to learn the hard way — by walking into a room without it, and understanding, only afterwards, what had been missing.

I was raised with African values. Not as a philosophy articulated and discussed, but as the texture of ordinary life. Respect your elders. Listen more than you speak. Work hard and do it quietly. Earn your place before you claim it. Do not announce yourself — demonstrate yourself, consistently, over time, and let that demonstration speak.

There is a genuine dignity in that approach. It is not timidity. It is a form of patience that trusts in the accumulation of evidence, that believes the work will eventually become its own argument. In many environments, that belief is correct.

In surgical training, those values helped me survive.

As a Black trainee, you become aware early — not always through anything overt, but through the texture of feedback and the tone of certain interactions and the things that are said differently to you than to others — that you are being observed in a particular way. The margin for error feels smaller. The interpretation of your behaviour feels less generous. You understand, even if no one has told you directly, that certain qualities — directness, assertiveness, the easy confidence that some people carry without appearing to have earned it — will not read the same way on you as they read on others.

So you adapt. You work quietly. You minimise friction. You manage perception carefully, because the cost of mismanaged perception is not abstract — it is an ARCP outcome, a PBA score, a reference that is slightly cooler than it should be.

You learn restraint. And restraint, in those years, protected me. It allowed me to endure environments that were not always fair, to build steadily without drawing unnecessary attention, to survive long enough to become competent in a setting that was not always inclined to wait for me to do so.

But there was another environment entirely where that same restraint failed me completely.

The first time I sat the surgical fellowship examination, I followed the advice I had been given.

Start gradually. Be measured. Don't rush to the answer. Take the examiners on the journey with you. Build the case methodically and let them see the reasoning develop.

It was sound advice, offered in good faith by people who had passed the examination and wanted me to do the same.

What it did not account for was how I would be perceived walking into that room.

I entered calm and composed and respectful. I built my answers methodically, step by step, exactly as I had been advised. I was thoughtful and careful. I was everything I had been told to be.

And they came for me almost immediately.

The questions sharpened. The interruptions arrived early, before I had established any rhythm. The tone shifted in a way that I recognised but could not in the moment correct. What I intended as composure was being read as uncertainty. What I meant as thoroughness was being interpreted as hesitation. The impression had formed — quickly, as impressions do — that I was someone who did not quite know where they were going.

Once that impression forms, the dynamic of an examination changes. The examiners begin to probe differently, to push harder, to test whether the hesitation they have identified is a surface feature or something deeper. And when you are pushing harder against someone who is already managing the psychological pressure of the room, you rarely discover what they actually know. You discover how they respond to pressure, which is a different and narrower question.

I left that examination knowing that something important had gone wrong. Not with my knowledge — my knowledge was sufficient. Something had gone wrong earlier than that, in the first minutes, before I had said anything that revealed what I actually knew.

The approach that had kept me safe in training had, in this different room, left me exposed.